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Cueto RJ, Kakalecik J, Burns MQ, Janke RL, Hones KM, Hao KA, Wright LT, Buchanan TR, Aibinder WR, Patrick MR, Schoch BS, King JJ. Reported outcome measures in complex fracture elbow dislocations: a systematic review. J Shoulder Elbow Surg 2024; 33:1709-1723. [PMID: 38609003 DOI: 10.1016/j.jse.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/04/2024] [Accepted: 02/17/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Complex elbow fracture dislocations, dislocation with fracture of one or several surrounding bony stabilizers, are difficult to manage and associated with poor outcomes. While many studies have explored treatment strategies but a lack of standardization of patient-reported outcome measures (PROMs) makes cross-study comparison difficult. In this systematic review, we aim to describe what injury patterns, measured outcomes, and associated complications are reported in the complex elbow fracture dislocation literature to provide outcome reporting recommendations that will facilitate improved future cross-study comparison. METHODS A systematic review was performed per Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles published between 2010 and 2022 reporting on adult patients who had a complex elbow fracture dislocation. Pathologic fractures were excluded. A bias assessment using the methodological index for nonrandomized studies criteria was conducted. For each article, patient demographics, injury pattern, outcome measures, and complications were recorded. RESULTS Ninety-one studies reporting on 3664 elbows (3654 patients) with an elbow fracture and dislocation (weighted mean age 44 years, follow-up of 30 months, 41% female) were evaluated. Of these, the injury pattern was described in 3378 elbows and included 2951 (87%) terrible triad injuries and 72 (2%) transolecranon fracture-dislocations. The three most commonly reported classification systems were: Mason classification for radial head fractures, Regan and Morrey coronoid classification for coronoid fractures, and O'Driscoll classification for coronoid fractures. Range of motion was reported in 87 (96%) studies with most reporting flexion (n = 70), extension (n = 62), pronation (n = 68), or supination (n = 67). Strength was reported in 11 (12%) studies. PROMs were reported in 83 (91%) studies with an average of 2.6 outcomes per study. There were 14 outcome scores including the Mayo Elbow Performance Score (n = 69 [83%]), the Disabilities of Arm, Shoulder and Hand (DASH) score (n = 28 [34%]), the visual analog scale for pain (n = 27 [33%]), QuickDASH score (n = 13 [15.7%]), and Oxford Elbow score (n = 5 [6.0%]). No significance was found between the number of PROMs used per article and the year of publication (P = .313), study type (P = .689), complex fracture pattern (P = .211), or number of elbows included (P = .152). CONCLUSION There is great heterogeneity in reported PROMs in the complex elbow fracture dislocation literature. Although there is no gold standard PROM for assessing complex elbow fracture dislocations, we recommend the use of at least the Mayo Elbow Performance Score and DASH outcomes measures as well as visual analog scale pain rating scale in future studies to facilitate cross-study comparisons.
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Affiliation(s)
- Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jaquelyn Kakalecik
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Madison Q Burns
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachel L Janke
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Logan T Wright
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew R Patrick
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
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Heifner JJ, Davis TA, Rowland RJ, Gomez O, Gray RR. Comparing internal and external stabilization for traumatic elbow instability: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:196-203. [PMID: 38706679 PMCID: PMC11065758 DOI: 10.1016/j.xrrt.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS. Methods A database query was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Population, Intervention, Comparison and Outcome characteristics for eligibility were the following: for patients over 18 years clinical outcomes were compared between an ExFix or the IJS for acute or chronic elbow instability. The Cochran risk of bias in nonrandomized studies of interventions and grades of recommendation, assessment, development, and evaluation framework were compiled for risk of bias and quality assessment. Results The rate of recurrent instability was 4.1% in the IJS group (N = 171) and 7.0% in the ExFix group (N = 435), with an odds ratio of 1.93 (95% confidence interval 0.88-4.23). The rate of device failure was 4.4% in the IJS group and 4.1% in the ExFix group. Pin-related complications occurred in 14.6% of ExFix cases. Complications in the IJS group were the following: 1 case of inflammatory reaction, 4 cases of post removal surgical site infection, and 5 symptomatic removals. Discussion The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. Although not statistically significant, the higher rate of recurrent instability following external fixation may be clinically important. The high rate of pin-related complications with external fixation is notable.
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Affiliation(s)
| | - Ty A. Davis
- Larkin Hospital Department of Orthopaedics, Coral Gables, FL, USA
| | | | - Osmanny Gomez
- Larkin Hospital Department of Orthopaedics, Coral Gables, FL, USA
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Hou F, Liang X, Fan W, Zhao F, Li D. Analysis of twenty-five cases of terrible triad injury of the elbow surgically treated with a single lateral approach. INTERNATIONAL ORTHOPAEDICS 2020; 45:241-246. [PMID: 33230605 DOI: 10.1007/s00264-020-04891-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective was to analyze the long-term clinical outcome of terrible triad injury of the elbow following surgical intervention with a single lateral approach. METHOD We treated twenty-five patients with terrible triad injury of the elbow from July 1, 2017, to June 30, 2020, and performed post hoc analysis. All patients underwent standardized surgery which entailed: plate fixation for the ulnar coronoid process, fixation or replacement of the radial head, and repair of the lateral ligament but not the medial collateral ligament. RESULTS We followed up each patient for an average of 22.9 months (range, 12 to 36 months) after surgery. Patients had an average angle scope of elbow flexion and extension that ranged from 8° to 120°. Average pronation of the elbow was 75° (range, 10°-85°), and average supination was 72° (range, 25°-80°). Patient-reported outcome measures were excellent: the DASH and Mayo elbow performance score (MEPS) were 96%. We were unable to follow-up one patient (4%). Among the remaining 24 patients, one patient (4%) presented with heterotopic ossification and stiffness following arthrolysis in the elbow one year after the initial surgery. We did not observe any joint dislocation, subluxation, or joint instability in the elbow after surgery. DISCUSSION The single lateral approach, a sequential surgery for terrible triad injury of the elbow, can improve initial stability of the elbow. Patients are able to perform rehabilitative exercises sooner in their recovery, which helps to reduce stiffness. Heterotopic ossification is also reduced.
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Affiliation(s)
- Fushan Hou
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Xiao Liang
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Wei Fan
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Feng Zhao
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Dong Li
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi, People's Republic of China.
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Podgórski AP, Kordasiewicz B, Pomianowski S. The column procedure preserves elbow stability on biomechanical testing. INTERNATIONAL ORTHOPAEDICS 2020; 44:911-918. [PMID: 32047962 PMCID: PMC7190588 DOI: 10.1007/s00264-020-04494-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/30/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The effect of open release of a post-traumatic elbow contracture on the stability of the joint has not been so far studied in vivo. Resection of elbow joint capsule, the key element of surgery, was reported to have no effect on the stability of cadaveric elbows. The joint capsule is yet known to participate in maintaining elbow stability as one of secondary stabilizers. METHODS We assessed elbow joint laxity in 39 patients who underwent an open contracture release via the 'column procedure' described by B. Morrey and P. Mansat within the preceeding three to nine months. The measurements were taken with an apparatus designed particularly for this experiment according to the predetermined protocol. A preliminary part of the experiment showed that there was no significant difference between laxity of two elbow joints in healthy volunteers. Laxity of the operated elbows could be then compared with the contralateral joints. RESULTS Mean absolute difference of laxity between healthy and operated elbows was 1.55° (0.1°-4.1°, SD = 1.1) being significantly lower than 2°, p = 0.0056. The difference of the joint laxity between the operated and healthy elbows did not differ statistically significantly by more than 0.6° from the difference of the laxity of two healthy elbows and, therefore, is not clinically noticeable. CONCLUSIONS Our experiment confirmed that the 'column procedure' is a safe procedure which does not compromise the stability of the elbow joint.
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Affiliation(s)
- Andrzej P Podgórski
- Department of Traumatology and Orthopaedic Surgery, Adam Gruca Clinical Hospital, Center for Postgraduate Medical Education, Otwock, Poland. .,Department of Neurosurgery, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland.
| | - Bartłomiej Kordasiewicz
- Department of Traumatology and Orthopaedic Surgery, Adam Gruca Clinical Hospital, Center for Postgraduate Medical Education, Otwock, Poland
| | - Stanisław Pomianowski
- Department of Traumatology and Orthopaedic Surgery, Adam Gruca Clinical Hospital, Center for Postgraduate Medical Education, Otwock, Poland
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Cui H, Sun Z, Ruan J, Yu Y, Fan C. Effect of enhanced recovery after surgery (ERAS) pathway on the postoperative outcomes of elbow arthrolysis: A randomized controlled trial. Int J Surg 2019; 68:78-84. [DOI: 10.1016/j.ijsu.2019.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
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Klug A, Buschbeck S, Gramlich Y, Buckup J, Hoffmann R, Schmidt-Horlohé K. Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid—a retrospective study of twenty-four patients. INTERNATIONAL ORTHOPAEDICS 2019; 43:2817-2824. [DOI: 10.1007/s00264-019-04354-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/30/2019] [Indexed: 12/18/2022]
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Cui HM, Yu YL, He Y, Kong LZ, Fan CY. Management of elbow dysfunction associated with giant cell tumor of the distal humerus: achieving oncologic safety and good function by a combined reconstruction. J Shoulder Elbow Surg 2019; 28:120-125. [PMID: 30348545 DOI: 10.1016/j.jse.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of our study was to evaluate the functional outcomes and oncologic results of elbow salvage surgery using arthrolysis combined with ligament repair and external fixation for reconstruction of the elbow after tumor excision and autografting. METHODS We retrospectively reviewed 6 patients with elbow dysfunction associated with giant cell tumor of the distal humerus. All patients were treated with our combined protocol. We assessed the Musculoskeletal Tumor Society system score, range of motion, Mayo Elbow Performance Score, recurrence, and complications for each patient. RESULTS The mean follow-up period was 48 months (range, 36-60 months). There were no cases of postoperative fracture, infection, elbow dislocation, elbow stiffness, or local recurrence. The average Musculoskeletal Tumor Society score was 28 of 30 points (93%; range, 87%-100%). The Mayo Elbow Performance Score improved from a mean of 61 points to 93 points, with mean flexion of 135° and mean extension of 3°. CONCLUSIONS Local tumor resection, autografting, and elbow reconstruction by arthrolysis combined with ligament repair and external fixation can be performed with oncologic safety and provide satisfactory functional outcomes with low complication rates.
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Affiliation(s)
- Hao-Min Cui
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ya-Ling Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yu He
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ling-Zhi Kong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cun-Yi Fan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China.
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Chen W, Zhang Y. Prominent and fruitful development of orthopaedic research in China. INTERNATIONAL ORTHOPAEDICS 2018; 42:455-459. [PMID: 29478208 DOI: 10.1007/s00264-018-3840-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
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